Hard to fault John Kasich for his all-out defense of the proposed Medicaid expansion. The governor even made the spiritual argument in his State of the State address last week, pointing to what he has “learned from the Good Book. … I can’t look at the disabled, I can’t look at the poor, I can’t look at the mentally ill, I can’t look at the addicted and think we ought to ignore them.”
Here was a civics lesson in our obligations to one another.
Kasich explained to his audience, including state lawmakers who must make the final decision about the expansion: “I just want to take you to one place. One day your son comes home, your daughter comes home, says, mom, my brain’s not working right — put it in your family. … on your doorstep, and you’ll understand how hard it is.”
Imagine you have a job without coverage, yet for all the sacrifice and saving, you cannot cover the cost of health insurance that would bring regular access to a primary care doctor. The Medicaid expansion would extend health coverage to those with incomes up to 138 percent of the poverty level, adding roughly 465,000 low-income Ohioans to the system.
The governor made a powerful case, speaking, as he must, for the state as a whole, taking a risk, showing a refreshing willingness to lead. Still, listening to the speech and weighing the reaction of his fellow Republicans, doubts hovered about the persuasiveness of this part of the pitch. Who likes to be told they don’t care enough about the poor, or lack an effective moral compass?
Something suggests that reluctant lawmakers, many well acquainted with the Good Book, won’t be shamed into saying yes to an expansion.
More effective may be good information. Take, for instance, a recent letter to key House members from David L. Bronson, a physician, professor of medicine and president of the Cleveland Clinic Regional Hospitals. He took the course of confronting directly and respectfully several misconceptions, such as Medicaid patients having poor health outcomes and the expansion likely a bad deal for Ohio doctors and hospitals.
Bronson notes that the Harvard School of Public Health looked at the expanded Medicaid programs in three states, Arizona, Maine and New York, and found a 6.1 percent reduction in mortality “when compared to neighboring states that did not expand Medicaid.” More, the reductions “were greatest for older adults, minority patients and those living in poor areas,” in other words, the likely Medicaid population.
Oregon expanded Medicaid in 2008. Bronson cites research showing that those gaining coverage “had improved physical, psychological and financial health, lower out-of-pocket medical expenditures and lower rates of depression.” He adds they also used more preventive services.
Without an expanded Medicaid, Ohio hospitals will face a steep challenge, as the federal government ends subsidies for uncompensated care. The pressure will be most severe for rural hospitals, likely involving job losses and reduced services. Yet, as Bronson explains, approve the expansion, and hospitals would benefit, $1 billion in annual uncompensated charity care reduced by $940 million.
Bronson also includes the reminder: If hospitals now lose 17 cents of every dollar spent on Medicaid, they “lose roughly 100 cents of every dollar treating uninsured people.”
So hospitals, leading employers in their communities, are enthusiastic supporters. They are, in part, because the expansion is part of a whole.
Take the insurance exchanges, making coverage available (with subsidies) through an online marketplace. Bronson highlights a potential problem: Fail to expand Medicaid, and it will be poorer Ohioans who still will lack coverage — without the means to buy on the exchange.
All of the advantages of expansion may make little difference to those who do not trust the federal government to keep its word and pick up 100 percent and eventually 90 percent of the cost. They fear the state stuck with a huge tab, failing in its duty to future generations.
The governor has proposed a “circuit breaker,” the state pulling out of the arrangement if the feds renege. More important, Kasich and Bronson each emphasize, again, the larger picture, in particular, the promising makeover of Medicaid now in the works in Ohio. Greg Moody and others in the Office of Health Transformation have been advancing efficiencies and better health outcomes, aiming to slow the rising cost.
Expand Medicaid, and you bring more people into this improved system. The state moves away from what clearly isn’t working, the presence of so many uninsured, here and elsewhere, contributing significantly to the expense of health care, the driver of the nation’s fiscal problems.
This isn’t a bid to expand a bad program. It is part of making the health-care system more affordable and effective. That won’t be easy, or quick, with something so large and complex. The Affordable Care Act is a platform for getting started, requiring many adjustments and fixes along the way. In that way, failing to expand Medicaid just makes things harder.
Douglas is the Beacon Journal editorial page editor. He can be reached at 330-996-3514, or emailed at mdouglas@thebeaconjournal.com.
